Supracolic total omentectomy is performed in conjunction with surgery
for ovarian carcinoma. It is important that patients with ovarian carcinoma
be operated on through an extended midline incision, generally one
from the xiphoid to the symphysis. It is difficult to perform an adequate
omentectomy through a transverse or Pfannenstiel incision, and all
too often such omentectomies result in incomplete excision of the tumor-bearing
omentum, leaving tumor in the remaining portion of the omentum. It
is instructive to discover on pathology the degree of micrometastasis
in the omentum associated with ovarian carcinoma when clinically the
omentum appears to be tumor free.

The purpose of the operation is to
remove the total omentum and all gross and microscopic metastases therein.

Physiologic Changes. None.

Points of Caution. The
omentum should be removed from the greater curvature of the stomach
and transverse colon. Care must be taken to secure the small omental
branches of the right gastric artery. Meticulous hemostasis should
be achieved.

Technique

The incision for total omentectomy must allow
exposure to the upper abdomen. This is very difficult with a
Maylard-type incision or any type of lower transverse abdominal
incision.

There is possible pathology in the omentum.
The dotted line represents the line of excision for
a supracolic omentectomy. Key anatomical features are the hepatic
flexure of the colon, the spleen and its vascular supply, the
splenic flexure of the colon, the cecum, and the rectum.

After removing the omentum from the hepatic
flexure of the transverse colon, the right gastroepiploic artery
and its short gastric branches are identified. Small defects
are made between each of the short gastric branches.

The LDS (linear dissecting)
stapler (United States Surgical Corp.) is applied to each of
the short gastric branches by manipulating the stapler into the
defects created in the omentum.

The omentum is completely removed from the
stomach.

The left gastroepiploic artery
has been stapled. The remaining omentum is removed from the transverse
colon.

The stomach and short gastric arteries are
noted. The transverse colon has been cleaned, and the omentum
totally removed.